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Challenging the Way Child Abuse is Treated

Nurse Stephanie Dallam offers therapy on her horse ranch

As an acute care nurse practitioner in pediatric surgery and trauma at the University of Missouri-Columbia in the early 1990s, Stephanie Dallam, then RN, MSN, FNP, was working with children who were suffering from illnesses and accidents, but also with young victims of abuse. One little boy came in suffering from multiple stab wounds inflicted by his mother, who had then set the house on fire, leaving him to die. He didn’t, but while Dallam cared for him, she was wracked by distress knowing this six-year-old could be entirely aware that his own mother tried to kill him, and she anguished about what this might do to him psychologically. He survived, but was his mental trauma was ever addressed?

It broke her heart, she said, because she knew in cases like this, “the wounds that were the worst were on the inside.” She saw other children who had been raped but whose physicians were only treating physical issues, and again she worried about the psychological consequences for these children.

While the medical center was good at the physical healing, she wondered whether enough was being done to ease the children’s mental torment after traumatic experiences. Their parents would bring the children back for follow-up care for physical injuries and report they were withdrawn or had nightmares. She was afraid that “nobody was asking the right questions” about how to help the children holistically.

Dallam took psychology courses to better understand the consequences of violence and trauma. She also noticed and became concerned about the growing backlash against sexual abuse survivors, and found it disturbing that recovered memories were often dismissed as false memories. She attributes this attitude to society’s “not dealing well” with the issue of childhood sexual abuse. That such memories were inauthentic “was what everyone wanted to hear.”

People want to be comfortable, and denying that such abuse happens is a way that people can remain comfortable and not have to worry about it too much. In addition, certain self-serving groups and individuals claim that taking sexual advantage of children does not harm them. And because these groups are often more organized than abuse victims, they are better able to perpetuate their ideas, in spite of how little merit their position has.

Armed With the Facts

To combat public misconceptions and fight the resulting further injustices that can affect victims of childhood abuse, in 1998 Stephanie helped to found the Leadership Council on Childhood Abuse and Interpersonal Violence. This is a national “virtual” network of highly respected physicians, researchers, clinicians, legal scholars, public policy analysts, and leaders in the fields of childhood maltreatment and interpersonal trauma.

Concerned with “preserving society’s commitment to protect its most vulnerable members,” they provide professionals and the public with research-based information, educate society about the role of childhood maltreatment in the development of health and mental disorders, and support justice for victims of violence.

Supplying fact-based information is one of the ways the Leadership Council tries to address some of the dysfunction in the legal system and increase awareness of the consequences of childhood abuse in public policy and the healthcare arena. Dallam is a paid consultant writer-researcher for the organization and also devotes additional volunteer time to its causes.­ As a writer-researcher, her job is to make sense of the data.

Joyanna Silberg, Ph.D., a clinical psychologist and expert in childhood sexual trauma, and Paul Fink, MD, a prominent psychiatrist and psychoanalyst and past-president of the American Psychiatric Association, are two of the other co-founders. Volunteer advisors have spent the past 13 years engaged in fighting misinformation, influencing public policy to better protect victims of abuse, and advocating on their behalf. The Leadership Council is an attempt to get healthcare and legal advocates organized and to rely on “strength in numbers” in order to create change. Returning Kids to Abusers

One example of how their work can challenge potentially dangerous misinformation was the group’s response to the Rind Study, published in 1998 in the Psychological Bulletin, the scientific journal of the American Psychological Association. This was a meta-analysis that purported to show that children are rarely harmed from sex abuse by adults.

Because the conclusions of the Rind Study ran contrary to 20 years of research showing a robust relationship between child sexual abuse and negative outcomes, researchers affiliated with the Leadership Council and from Stanford and Texas A&M did an independent review and re-analysis of some five dozen studies.

They proved that the Rind Study was seriously flawed and presented a rebuttal to the American Psychological Association. The clarification was important because of the way such information can influence court decisions about abuse cases.

As unbelievable as it sounds, Dallam says that children in disputed custody cases are too often given over to the care of people accused of abusing them. “Even if the children, social worker, doctor and therapist say the child has been abused, the judge still awards custody to the abuser.” The Leadership Council estimates this happens to about 5,000 children a year!

But through a new grant from the Department of Justice – The Office of Violence Against Women, Dallam will being working this summer on a project in collaboration with DV LEAP (Domestic Violence – Legal Empowerment and Appeal Project). The goal of this program is to provide for the training of judges and other court personnel, such as advocates and attorneys, about potential failures in the system that allow this to happen and to educate them about how to make more informed decisions.

As a nurse, Dallam has also been concerned about how a history of sexual abuse can have long-term ramifications for a patient’s healthcare. Her Ph.D. dissertation in 2010 was called “A Model of the Retraumatization Process: A Metasynthesis of Childhood Sexual Abuse Survivors’ Experiences in Healthcare.” She says that one in four women and one in six men is likely to be an abuse survivor.

At some point in the future, she plans to do training for healthcare professionals that will stress the importance of dealing sensitively with the discomfort sexual abuse victims may feel with certain healthcare exams, diagnostic procedures and treatments. She stresses it is not the environment or procedures themselves that result in re-traumatization, but the patients’ re-experiencing feelings of loss of control. In addition to ensuring compassionate delivery of healthcare services for these damaged individuals, understanding their reactions may lead to lessening their avoidance of healthcare environments and treatments, better patient compliance and ultimately better outcomes.

Therapeutic for All

At present she is busy with a new, very different venture that will also benefit young people who have suffered from abuse, homelessness or who have developmental challenges. She and a friend bought an old rundown farm 30 minutes outside Kansas City where they will offer a therapeutic riding program to give such children feelings of personal empowerment. The Blue Heron Ranch has been established as a 501 (c)(3) nonprofit organization. (Dallam is also a paralegal, which came in handy in setting up the organization.) Her friend Lida owns nine horses and a donkey which will be used in the program that opened this summer.

The past two years have been spent fixing up the property, repairing barns, riding tractors and training horses — all things that nurses and researchers don’t normally do so often. She says all the hard physical labor and being around animals has been a wonderful release for her, since the difficult topics she deals with constantly — the heartbreaking and frustrating issues of childhood abuse — can be very stressful.

The first guests will be a group of children with autism. Dallam says that most children who cannot relate well to people and who are at-risk of maladaptive coping strategies can benefit from such therapeutic work with animals. “It’s a chance,” she says, “to let them be a child and let go of their feeling there is something wrong with them.” And because it gives her a chance to help children on a more personal level again, the project is also therapeutic for her.